| Backgroud:TKA has become an effective treatment of severe knee joint lesions after several decades of development. It has extensively carried out. Lower extremity DVT is a serious complication after total knee arthroplasty. Its serious consequences can be secondary to pulmonary embolism and induce to death. If you do not take preventive measures,the incidence of DVT after TKA is 40% -60%.The occurrence rate of fatal pulmonary embolism is about 0.5% -2.0%. DVT is one of the important factors which affect the security of TKA. Therefore, effec- tively preventing DVT after TKA is still a problem to be solved in clinical.There is still not a drug (or combination) can perfectly solute DVT after TKR. The best way of drugs and drugs still need further be studied. Now we commonly use LMWH associating with machinery measures. LMWH means less than 6.5kDa molecular weight heparin.It may be directly derived from unfractionated heparin or isolated after the separation of degradation of unfrac- tionated heparin . LMWH has a selective activity of anti-clotting factorâ…¹a. While it has effect on thrombin and other coagulation factors . Some domestic experts ( Qiu Xing, Dai Min-jung, YANG Qing-ming, etc) issued a "Expert advice of Preventing DVT after major surgery ", that provided evidence for preventing the occurrence of DVT after major surgery . However, some literature and clinical practice have confirmed that low molecular weight hepar- in may and increase the risk of bleeding , epidural hematoma, cerebral hemo- rrhage and gastrointestinal bleeding. Some patients couldn't receive this way. The purpose of this study was to discuss clinical results of LMWH preventing DVT after TKA, and to evaluate the safety. for clinical use of low molecular weight heparin after total knee arthroplasty Prevention of deep vein thrombosis reference.We will provide reference for the use of LMWH in TKA prebenting DVT after TKA.Objective:We study the effect of LMWH in preventing DVT after TKA, and to evaluate the clinical effect. We will provide reference for the use of LMWH in TKA prebenting DVT after TKA.Methods:From February 2008 to October 2009 we performed 40 patients of TKA in the China Japan Union Hospital of JiLin University, and distributed in 2 groups randomly. One group had been given LWMH. The other was control group. The experiment group: patients were given LMWH 1 day after operation, 5000u subcutaneous injection once a day 24h ~7d after surgery. Patients were not given any other anticoagulants, and the drugs which can affect coagulation. The control group: patients did not receive LMWH and any other anticoagulants, and the drugs which can affect coagulation. Two groups received the same mathods for preventing DVT. All patients were received Color Doppler ultrasonography for bilater allower extremities after operation to detect DVT. We observe and record the volume of bleeding and volume of drainage. Then we check blood routine test and clotting routine test of all the two groups of patients , and to compare the result of hemoglobin (Hb), platelet count (PC) , ren blood cells and APTT.Results:All patients wre received Color Doppler ultrasonography before opera- tion , and they were all not have DVT. DVT occured in 0.00% of the LMWH patients was significant (p<0.05) compared to the control group in 30.00%. All patients didn't occured PE. Patients of the experiment group didn't occur severse events and allergic reactions. Patients of this group didn't happen bleeding after operation. Hb,PC and APTT of the two groups patients was not siginificant (p>0.05).Conclusion1.Although the sample of this study is still insufficient , it still shows that the incidence of DVT after TKA is high in our country to some extent.2.LMWH can significantly prevent the incidence of DVT after TKA, have a good safety, and few adverse reaction.
|
PDF Full Text Request